From the Guidelines
Post-exposure prophylaxis (PEP) for HIV typically consists of a 28-day course of three antiretroviral medications, ideally started within 72 hours of exposure, as recommended by the most recent guidelines 1. The preferred regimen includes tenofovir disoproxil fumarate (TDF) 300 mg plus emtricitabine (FTC) 200 mg once daily, combined with raltegravir 400 mg twice daily or dolutegravir 50 mg once daily. Alternative regimens may include TDF/FTC plus darunavir/ritonavir. For hepatitis C exposures, there is no recommended standard PEP regimen; instead, monitoring for infection with HCV RNA testing at baseline, 4-6 weeks, and 4-6 months is recommended, as suggested by various studies 1. If acute HCV infection is detected, early treatment with direct-acting antivirals such as sofosbuvir/velpatasvir for 8-12 weeks is highly effective. The effectiveness of HIV PEP is based on preventing viral integration into host DNA during the initial infection phase, while HCV monitoring allows for early detection and treatment before chronic infection develops. Key considerations for PEP include:
- Starting treatment as soon as possible after exposure, ideally within 72 hours 1
- Baseline testing of the source individual (if possible) and the exposed person to guide management decisions
- Counseling about potential medication side effects, adherence importance, and follow-up testing schedules for optimal outcomes
- Monitoring for potential side effects and adjusting the regimen as needed, based on the most recent evidence 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
HIV Postexposure Prophylaxis (PEP) Medications
- The study 2 evaluated a novel 3-drug PEP regimen, consisting of raltegravir, tenofovir DF, and emtricitabine, and found it to be safe, tolerable, and effective in preventing HIV infection.
- Another study 3 compared the efficacy and safety of two antiretroviral first-line combinations, including dolutegravir with emtricitabine and tenofovir alafenamide, and found them to be non-inferior to a third regimen.
- A phase 3 study 4 found that a fixed-dose combination of bictegravir, emtricitabine, and tenofovir alafenamide was non-inferior to dolutegravir-containing regimens for initial treatment of HIV-1 infection.
Duration of Treatment
- The study 2 found that 57% of participants completed the 3-drug PEP regimen as prescribed, and 27% took their medicine daily, but sometimes missed the second daily dose of raltegravir.
- The duration of treatment for HIV PEP is typically 28 days, but this may vary depending on the specific regimen and clinical guidelines.
- A study 5 provides guidance for nurse practitioners on managing treatment for people exposed to HIV, including the importance of adherence to the treatment protocol.
Hepatitis C Postexposure Prophylaxis
- There is limited information available on hepatitis C postexposure prophylaxis in the provided studies.
- However, a study 6 investigated the impact of a combination of tenofovir disoproxil fumarate/emtricitabine with raltegravir or dolutegravir or elvitegravir/cobicistat on renal function in HIV-1 antiretroviral naïve patients, which may be relevant to hepatitis C co-infection.
Side Effects and Adherence
- The study 2 found that the most common side effects reported included nausea or vomiting, diarrhea, headache, fatigue, abdominal symptoms, and myalgias or arthralgias, all of which were mild and tended to be self-limited.
- Adherence to the treatment regimen is crucial for effective HIV PEP, and nurse practitioners play an essential role in managing treatment and following up on patients' response and adherence to the treatment protocol 5.